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Demaeyer N, Bruyneel M. Factors Associated with Persistent Obstructive Sleep Apnea After Bariatric Surgery: A Narrative Review. Nat Sci Sleep 2024; 16:111-123. [PMID: 38348054 PMCID: PMC10859698 DOI: 10.2147/nss.s448346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m2, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11-12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.
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Affiliation(s)
- Nathalie Demaeyer
- Department of Pneumology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Bruyneel
- Department of Pneumology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pneumology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Ross M, Fonseca P, Overeem S, Vasko R, Cerny A, Shaw E, Anderer P. Autonomic arousal detection and cardio-respiratory sleep staging improve the accuracy of home sleep apnea tests. Front Physiol 2023; 14:1254679. [PMID: 37693002 PMCID: PMC10484584 DOI: 10.3389/fphys.2023.1254679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction: The apnea-hypopnea index (AHI), defined as the number of apneas and hypopneas per hour of sleep, is still used as an important index to assess sleep disordered breathing (SDB) severity, where hypopneas are confirmed by the presence of an oxygen desaturation or an arousal. Ambulatory polygraphy without neurological signals, often referred to as home sleep apnea testing (HSAT), can potentially underestimate the severity of sleep disordered breathing (SDB) as sleep and arousals are not assessed. We aim to improve the diagnostic accuracy of HSATs by extracting surrogate sleep and arousal information derived from autonomic nervous system activity with artificial intelligence. Methods: We used polysomnographic (PSG) recordings from 245 subjects (148 with simultaneously recorded HSATs) to develop and validate a new algorithm to detect autonomic arousals using artificial intelligence. A clinically validated auto-scoring algorithm (Somnolyzer) scored respiratory events, cortical arousals, and sleep stages in PSGs, and provided respiratory events and sleep stages from cardio-respiratory signals in HSATs. In a four-fold cross validation of the newly developed algorithm, we evaluated the accuracy of the estimated arousal index and HSAT-derived surrogates for the AHI. Results: The agreement between the autonomic and cortical arousal index was moderate to good with an intraclass correlation coefficient of 0.73. When using thresholds of 5, 15, and 30 to categorize SDB into none, mild, moderate, and severe, the addition of sleep and arousal information significantly improved the classification accuracy from 70.2% (Cohen's κ = 0.58) to 80.4% (κ = 0.72), with a significant reduction of patients where the severity category was underestimated from 18.8% to 7.3%. Discussion: Extracting sleep and arousal information from autonomic nervous system activity can improve the diagnostic accuracy of HSATs by significantly reducing the probability of underestimating SDB severity without compromising specificity.
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Affiliation(s)
- Marco Ross
- Philips Sleep and Respiratory Care, Vienna, Austria
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pedro Fonseca
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Philips Research, Eindhoven, Netherlands
| | - Sebastiaan Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, Netherlands
| | - Ray Vasko
- Philips Sleep and Respiratory Care, Pittsburgh, PA, United States
| | | | - Edmund Shaw
- Philips Sleep and Respiratory Care, Pittsburgh, PA, United States
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Borrelli M, Corcione A, Cimbalo C, Annunziata A, Basilicata S, Fiorentino G, Santamaria F. Diagnosis of Paediatric Obstructive Sleep-Disordered Breathing beyond Polysomnography. Children (Basel) 2023; 10:1331. [PMID: 37628330 PMCID: PMC10452996 DOI: 10.3390/children10081331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice.
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Affiliation(s)
- Melissa Borrelli
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Adele Corcione
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Chiara Cimbalo
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Anna Annunziata
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Simona Basilicata
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
| | - Giuseppe Fiorentino
- Department of Intensive Cure, Unit of Respiratory Pathophysiology, Monaldi Hospital, 80131 Naples, Italy; (A.A.); (G.F.)
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Paediatric Pulmonology, Federico II University, 80131 Naples, Italy; (A.C.); (C.C.); (S.B.); (F.S.)
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Yilmaz Yegit C, Erdem Eralp E, Gokdemir Y, Ergenekon P, Sabancı M, Ay P, Karadag B, Ersu R. Night-to-night variability of polygraphy in children with sleep disordered breathing symptoms. Pediatr Pulmonol 2023. [PMID: 37014151 DOI: 10.1002/ppul.26404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/07/2022] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Polygraphy (PG) can be used as an alternative test for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. Night-to-night variability of PG in children is not known. Our aim was to determine whether a single night PG was reliable for OSAS diagnosis in children with symptoms of sleep-disordered breathing (SDB). MATERIALS AND METHODS Otherwise healthy children who had been evaluated for symptoms of SDB were included. Two nocturnal PGs were performed 2-7 days apart. Demographic and clinical characteristics, Pediatric Sleep Questionnaire, and modified Epworth Sleepiness Scale were recorded. OSAS was diagnosed if obstructive apnea-hypopnea index was (oAHI) ⩾ 1/h and classified as mild (oAHI: 1-4.9/h), moderate (oAHI: 5-9.9/h), and severe (oAHI ⩾ 10/h). RESULTS Forty-eight patients were included (37.5% female, age 10.8 ± 3.9 years) to the study. There were no significant differences in oAHI values and other respiratory parameters between the two PGs (p > 0.05). Thirty-nine children were diagnosed with OSAS if the highest oAHI over any single night was used for diagnosis. Thirty-three of the 39 children (84.6%) were diagnosed with OSAS with the first PG while 35 of 39 (89.7%) children were diagnosed with OSAS with the second PG. There was an agreement for identifying OSAS and its severity between the two PGs in our study even though there were few individual intra-subject differences in oAHI. CONCLUSION There was no significant first-night effect for PG in this study which suggests that a single night PG is adequate for diagnosis of OSAS in children with SDB- related symptoms.
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Affiliation(s)
- Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Meltem Sabancı
- Sleep Center, Marmara University, School of Medicine, Istanbul, Turkey
| | - Pinar Ay
- Division of Public Health, Marmara University, School of Medicine, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Refika Ersu
- Division of Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Bartolucci ML, Bortolotti F, Pelligra I, Stipa C, Sorrenti G, Incerti-Parenti S, Alessandri-Bonetti G. Prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study. J Oral Rehabil 2023; 50:318-323. [PMID: 36681885 DOI: 10.1111/joor.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is characterised by partial or complete obstruction of the upper airways during sleep and it has been associated with temporomandibular disorders (TMDs) on the basis of several pathophysiological hypotheses. OBJECTIVES To assess the prevalence of TMDs in a population of patients affected by OSA compared to a control group of subjects not affected by OSA. METHODS A cross-sectional controlled study was conducted on a group subjects studied by polygraphy (PG) at the snoring section of the ENT department, Sant'Orsola-Malpighi Hospital - University of Bologna. Patients who received a diagnosis of OSA were included in the study group and subjects with a negative PG diagnosis for Sleep Disordered Breathing and PG respiratory pattern that did not suggest the occurrence of sleep disorders were enrolled in the control group. Both the subjects included in the study group and the control group underwent an examination following the Diagnostic Criteria for Temporomandibular Disorders Axis I and II. RESULTS Forty-three OSA patients (29 M, 16 F, mean age 52.26 ± 11.40) and 43 healthy controls (25 M, 18 F, mean age 49.95 ± 7.59) were included in the study. No significant differences were found between groups in demographic data. TMD prevalence and Axis II results did not differ between groups. CONCLUSIONS This paper does not highlight a higher prevalence of TMDs in adults with OSA compared to healthy controls. Further high-quality studies are needed to confirm the results and to give possible pathophysiological explanations, providing reliable evidence.
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Affiliation(s)
- Maria Lavinia Bartolucci
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Bortolotti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Irene Pelligra
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy
| | - Chiara Stipa
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Sorrenti
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy
| | - Serena Incerti-Parenti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Giulio Alessandri-Bonetti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
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Borrelli M, Corcione A, Rongo R, Cantone E, Scala I, Bruzzese D, Martina S, Strisciuglio P, Michelotti A, Santamaria F. Obstructive Sleep Apnoea in Children with Down Syndrome: A Multidisciplinary Approach. J Pers Med 2022; 13:jpm13010071. [PMID: 36675732 PMCID: PMC9862921 DOI: 10.3390/jpm13010071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
A comprehensive evaluation of obstructive sleep apnoea (OSA) may allow for the development of more efficient management of Down syndrome (DS). We aimed to evaluate the effect of a multidisciplinary approach to DS with OSA. A total of 48 DS children aged 4−12 years were prospectively investigated with nasal endoscopy, orthodontic examination, and overnight polygraphy (PG); the Italian Child Sleep Habits Questionnaire (CSHQ-IT) was filled out by the mothers. The total CSHQ-IT score was 63 (96% of children reporting sleep problems). The major ear, nose, and throat characteristics were enlarged palatine tonsils (62%), adenoid tonsils (85%), and chronic rhinosinusitis (85%). DS children showed orthognathic profile in 68% of cases, class I relationship in 63%, and cross-bite in 51%. PG revealed OSA in 67% of cases (37% mild, 63% moderate−severe). The oxygen desaturation index (ODI) was higher in the group with OSA (5.2) than with non-OSA (1.3; p < 0.001). The ODI was higher (p = 0.001) and SpO2 lower (p = 0.03) in children with moderate−severe OSA than with mild OSA. The apnoea−hypopnea index (AHI) and percentage time with SpO2 < 90% were higher in DS children with grade III than with grade I or II adenoids (5 vs. 1, p = 0.04, and 1.2 vs. 0.1, p = 0.01, respectively). No significant correlations were found between PG and the total CSHQ-IT score or orthodontic data. However, children showing associated cross-bite, grade III adenoids and size 3 or 4 palatine tonsils showed higher AHI and ODI than those without (p = 0.01 and p = 0.04, respectively). A coordinated multidisciplinary approach with overnight PG is a valuable tool when developing diagnostic protocols for OSA in DS.
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Affiliation(s)
- Melissa Borrelli
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, 80131 Naples, Italy
| | - Adele Corcione
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, 80131 Naples, Italy
| | - Roberto Rongo
- Department of Neurosciences, Reproductive Sciences and Odontostomatologic Sciences, School of Orthodontics, Federico II University, 80131 Naples, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive Sciences and Ear Nose Throat Section, Federico II University, 80131 Naples, Italy
| | - Iris Scala
- Department of Maternal and Child Health, Clinical Genetics, Federico II University, 80131 Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, Federico II University, 80131 Naples, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84121 Salerno, Italy
| | - Pietro Strisciuglio
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, 80131 Naples, Italy
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive Sciences and Odontostomatologic Sciences, School of Orthodontics, Federico II University, 80131 Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-08-1746-3495
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Kondratov A, Konyukhov V, Yamilinets S, Marchenko E, Baigonakova G. Compression Relaxation of Multi-Structure Polymer Composites in Penetrating Liquid Medium. Polymers (Basel) 2022; 14:polym14235177. [PMID: 36501569 PMCID: PMC9738001 DOI: 10.3390/polym14235177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
Multi-structural polymer composites are widely used in the mechanical engineering, automotive, aviation and oil refining industries, as well as in the printing industry as a shock-absorbing deckle on the offset cylinders of printing machines. During offset printing, composites come into contact with inks and washing solutions, the components of which penetrate the material and cause the polymers to swell. This process degrades the print quality, and for this reason the study of its features is relevant. The prerequisites for this work are the study of the fundamental laws of diffusion and sorption of liquids by polymers with different micro- and macro-structures in different physical states and in different forms (e.g., films, sheets, fibers and fabrics). The combination of polymer materials in the composition of multi-structural fabric blankets makes it possible to obtain materials with unique mechanical properties and high resistance to liquid penetrating media and to use them in high-tech processes of multi-color printing with high resolution and color rendering. This article reports for the first time the kinetics and thermodynamics results obtained from the swelling of multi-structural polymeric blankets in solvents used in printing, and the effect of sorption of different polar liquids on the viscoelastic strain under compression during the operation of the damping systems of printing machines. Using mathematical models of activated liquid diffusion in polymers and deformation of a viscoelastic body, the swelling rate constants, solvent diffusion coefficients (the kinetic characteristics of the swelling process) and Flory−Huggins parameters (the thermodynamic characteristics of the interaction of the solvent with the composite) for composite−solvent systems with several chemical composition variants were determined. The elastic modulus and the viscosity coefficient of the composite under liquid saturation were calculated based on the experimental cyclic compression data. The range of change in the compression and restoration times of the polymeric blankets (0.09 s ÷ 0.78 s) was determined. It was shown that the composite swelled to a limited extent in all the studied liquids. All solvents used were thermodynamically poor (χ > 0.5). It has been established that rubber−fabric blankets coated with nitrile rubber are the least resistant to the action of dichloroethane, and that blankets with layers of polyolefins are not resistant to ethyl acetate. Water significantly affects the physicochemical properties of rubber−fabric blankets with a large proportion of cotton fabric layers. The data obtained can serve as a basis for optimizing the compositions of inks and cleaning solutions, as well as a theoretical basis for the thermodynamics of composite−solvent systems.
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Affiliation(s)
- Alexander Kondratov
- Department of Innovative Materials in the Print Media Industry, Moscow Polytechnic University, 107023 Moscow, Russia
| | - Valery Konyukhov
- Department of Physical Chemistry, Mendeleev University of Chemical Technology, 125047 Moscow, Russia
| | - Stanislav Yamilinets
- Department of Innovative Materials in the Print Media Industry, Moscow Polytechnic University, 107023 Moscow, Russia
| | - Ekaterina Marchenko
- Laboratory of Superelastic Biointerfaces, National Research Tomsk State University, 634045 Tomsk, Russia
| | - Gulsharat Baigonakova
- Laboratory of Superelastic Biointerfaces, National Research Tomsk State University, 634045 Tomsk, Russia
- Correspondence:
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Zaffanello M, Pietrobelli A, Gozal D, Nosetti L, La Grutta S, Cilluffo G, Ferrante G, Piazza M, Piacentini G. Cluster Analysis of Home Polygraphic Recordings in Symptomatic Habitually-Snoring Children: A Precision Medicine Perspective. J Clin Med 2022; 11:jcm11195960. [PMID: 36233827 PMCID: PMC9571925 DOI: 10.3390/jcm11195960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Background: Sleep-disordered breathing (SDB) is a frequent problem in children. Cluster analyses offer the possibility of identifying homogeneous groups within a large clinical database. The application of cluster analysis to anthropometric and polysomnographic measures in snoring children would enable the detection of distinctive clinically-relevant phenotypes; (2) Methods: We retrospectively collected the results of nocturnal home-based cardiorespiratory polygraphic recordings and anthropometric measurements in 326 habitually-snoring otherwise healthy children. K-medoids clustering was applied to standardized respiratory and anthropometric measures, followed by Silhouette-based statistics. Respiratory Disturbance Index (RDI) and oxygen desaturation index (≤3%) were included in determining the optimal number of clusters; (3) Results: Mean age of subjects was 8.1 ± 4.1 years, and 57% were males. Cluster analyses uncovered an optimal number of three clusters. Cluster 1 comprised 59.5% of the cohort (mean age 8.69 ± 4.14 years) with a mean RDI of 3.71 ± 3.23 events/hour of estimated sleep (e/ehSleep). Cluster 2 included 28.5% of the children (mean age 6.92 ± 3.43 years) with an RDI of 6.38 ± 3.92 e/ehSleep. Cluster 3 included 12% of the cohort (mean age 7.58 ± 4.73 years) with a mean RDI of 25.5 ± 19.4 e/ehSleep. Weight z-score was significantly lower in cluster 3 [-0.14 ± 1.65] than in cluster 2 [0.86 ± 1.78; p = 0.015] and cluster 1 [1.04 ± 1.78; p = 0.002]. Similar findings emerged for BMI z scores. However, the height z-score was not significantly different among the 3 clusters; (4) Conclusions: Cluster analysis of children who are symptomatic habitual snorers and are referred for clinical polygraphic evaluation identified three major clusters that differed in age, RDI, and anthropometric measures. An increased number of children in the cluster with the highest RDI had reduced body weight. We propose that the implementation of these approaches to a multicenter-derived database of home-based polygraphic recordings may enable the delineation of objective unbiased severity categories of pediatric SDB. Our findings could be useful for clinical implementation, formulation of therapeutic decision guidelines, clinical management, prevision of complications, and long-term follow-up.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
- Correspondence:
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - David Gozal
- Departments of Child Health, and Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, F. Del Ponte Hospital, Insubria University, 21100 Varese, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology (IFT), National Research Council, 90146 Palermo, Italy
| | - Giovanna Cilluffo
- Department of Earth and Marine Sciences, University of Palermo, 90133 Palermo, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37129 Verona, Italy
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Zarei SA, Yahyavi SS, Salehi I, Kazemiha M, Kamali AM, Nami M. Toward reanimating the laughter-involved large-scale brain networks to alleviate affective symptoms. Brain Behav 2022; 12:e2640. [PMID: 35687720 PMCID: PMC9304826 DOI: 10.1002/brb3.2640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/03/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The practicality of the idea whether the laughter-involved large-scale brain networks can be stimulated to remediate affective symptoms, namely depression, has remained elusive. METHODS In this study, 25 healthy individuals were tested through 21-channel quantitative electroencephalography (qEEG) setup upon resting state and while submitted to standardized funny video clips (corated by two behavioral neuroscientists and a verified expert comedian, into neutral and mildly to highly funny). We evaluated the individuals' facial expressions against the valence and intensity of each stimulus through the Nuldos face analysis software. The study also employed an eye-tracking setup to examine fixations, gaze, and saccadic movements upon each task. In addition, changes in polygraphic parameters were monitored upon resting state and exposure to clips using the 4-channel Nexus polygraphy setup. RESULTS The happy facial expression analysis, as a function of rated funny clips, showed a significant difference against neutral videos (p < 0.001). In terms of the polygraphic changes, heart rate variability and the trapezius muscle surface electromyography measures were significantly higher upon exposure to funny vs. neutral videos (p < 0.5). The average pupil size and fixation drifts were significantly higher and lower, respectively, upon exposure to funny videos (p < 0.01). The qEEG data revealed the highest current source density (CSD) for the alpha frequency band localized in the left frontotemporal network (FTN) upon exposure to funny clips. Additionally, left FTN acquired the highest value for theta coherence z-score, while the beta CSD predominantly fell upon the salience network (SN). CONCLUSIONS These preliminary data support the notion that left FTN may be targeted as a cortical hub for noninvasive neuromodulation as a single or adjunct therapy in remediating affective disorders in the clinical setting. Further studies are needed to test the hypotheses derived from the present report.
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Affiliation(s)
- Shahab A Zarei
- Institute of Neuroscience, The Center of Excellence in Brain and Intelligence Technology, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Chinese Academy of Sciences, Shanghai, China
| | - Seyedeh-Saeedeh Yahyavi
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society, Fars Chapter, Shiraz, Iran.,Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Salehi
- DANA Brain Health Institute, Iranian Neuroscience Society, Fars Chapter, Shiraz, Iran
| | - Milad Kazemiha
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society, Fars Chapter, Shiraz, Iran.,Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali-Mohammad Kamali
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society, Fars Chapter, Shiraz, Iran.,Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society, Fars Chapter, Shiraz, Iran.,Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, California, USA.,Harvard Alumni for Mental Health, Middle-East Ambassador, Dubai, UAE
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10
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Kazubowska-Machnowska K, Jodkowska A, Michalek-Zrabkowska M, Wieckiewicz M, Poreba R, Dominiak M, Gac P, Mazur G, Kanclerska J, Martynowicz H. The Effect of Severity of Obstructive Sleep Apnea on Sleep Bruxism in Respiratory Polygraphy Study. Brain Sci 2022; 12:brainsci12070828. [PMID: 35884635 PMCID: PMC9313411 DOI: 10.3390/brainsci12070828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) and sleep bruxism (SB) may appear concomitantly. Data on the relationship between OSA and SB are limited. It was shown that in a population with an increased risk of OSA, OSA was dependently correlated with SB on the degree of OSA severity only in mild and moderate cases of OSA. We aimed to confirm this relationship and affecting factors in a group of dental office patients in a prospective, observational study. Adult patients (n = 119) were evaluated using respiratory polygraphy. The risk of OSA was assessed using a STOP-Bang questionnaire (SBQ). The episodes of bruxism and respiratory events were scored according to the standards of the American Academy of Sleep Medicine. The prevalence of OSA and SB was found to be 63.02% and 41.17%, respectively. The bruxism episode index (BEI) was increased in the group with a higher risk of OSA (SBQ ≥ 3) compared to the group with a lower risk of OSA (3.49 ± 3.63 vs. 2.27 ± 2.50, p = 0.03). The sensitivity and specificity of the SBQ were not sufficient to predict SB. A positive linear correlation between AHI and BEI in the group with AHI < 23/h was found. The study confirmed that OSA was associated with SB in the group of patients with OSA and/or SB risk. The relationship between OSA and SB depended on the degree of severity of OSA and occurred in mild and moderate cases of OSA.
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Affiliation(s)
| | - Anna Jodkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
- Correspondence: ; Tel.: +48-71-736-4000
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland;
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Marzena Dominiak
- Department of Oral Surgery, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland; (K.K.-M.); (M.D.)
| | - Pawel Gac
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, 7 Mikulicza-Radeckiego St., 50-345 Wroclaw, Poland;
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Justyna Kanclerska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland; (A.J.); (R.P.); (G.M.); (J.K.); (H.M.)
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11
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Kryukov AI, Poluektov MG, Ivoylov AY, Tardov MV, Turovsky AB, Arkhangelskaya II, Gavrilenko MA. [Diagnosis and correction of the obstructive sleep apnea syndrome in children with tonsillar ring pathological conditions]. Vestn Otorinolaringol 2022; 87:4-8. [PMID: 35274885 DOI: 10.17116/otorino2022870114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize the results of a study of the clinical and polygrapic features of sleep in children with pathologic conditions of the tonsillar ring and obstructive sleep apnea. Tonsillar hypertrophy is the most common cause of obstructive sleep apnea in children. Using the data of overnight polysomnographic study and/or nocturnal pulse oximetry, groups of patients were distinguished depending on the presence and severity of their sleep breathing disorders. The effectiveness of adenotomy, adenotonsillotomy and/or adenotonsillectomy in children is demonstrated, depending on the severity of obstructive sleep apnea syndrome. Evaluation of breathing in sleeping children by polygraphic methods is necessary for early detection of obstructive sleep apnea syndrome and monitoring the effectiveness of surgical treatment.
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Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - M G Poluektov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A Yu Ivoylov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Speransky Pediatric Municipal Clinical Hospital No. 9, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - M V Tardov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A B Turovsky
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - I I Arkhangelskaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Gavrilenko
- Sechenov First Moscow State Medical University, Moscow, Russia
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12
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Buratti L, Rocchi C, Totaro V, Broggi S, Lattanzi S, Viticchi G, Falsetti L, Silvestrini M. Sex-Related Differences in Polygraphic Parameters in a Population of Patients with Obstructive Sleep Apnea Syndrome. CNS Neurol Disord Drug Targets 2022; 21:492-499. [PMID: 34719367 DOI: 10.2174/1871527320666211022104140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/16/2021] [Accepted: 01/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Sex-related differences in the prevalence and clinical presentation of Obstructive Sleep Apnea Syndrome (OSAS) have been widely documented. The aim of this study was to investigate the influence of patients' sex on polygraphic parameters with particular attention to sleep autonomic changes in a population of OSAS patients. METHODS Sixty OSAS patients aged 55-65 years (30 men, 30 women) were enrolled. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness with the Epworth Sleepiness Scale (ESS). The presence of respiratory events and autonomic changes during the night was investigated by polygraphy. RESULTS Similar main cardiovascular risk factors prevalence was observed in both men and women. We observed a significant difference in PSQI (higher in women, p=0.0001) and ESS (higher in men, p=0.004) scores. Snoring (p=0.033), supine AHI (p=0.004), T90 (p=0.021), LO2 (p=0.0001), LF/HF ratio and LF (p=0.0001) were significantly higher in men. Sex differences in PSQI mean score and LF/HF ratio variability were preserved in all the subgroups of OSA severity. CONCLUSION The influence of sex in modulating cardiovascular risk is a widely discussed topic. In our study, men showed more severe polygraphic parameters and an increase in LF/HF ratio compared to women. The results of our investigation suggest the relevance of delivering information about the different expressions of OSAS in men and women in order to improve diagnostic skills and in-depth prevention approaches.
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Affiliation(s)
- Laura Buratti
- Neurological Clinic, Marche Polytechnic University, via Conca 71, Ancona, 60020, Italy
| | - Chiara Rocchi
- Neurological Clinic, Marche Polytechnic University, via Conca 71, Ancona, 60020, Italy
| | - Viviana Totaro
- Neurological Clinic, Marche Polytechnic University, via Conca 71, Ancona, 60020, Italy
| | - Serena Broggi
- Neurological Clinic, Marche Polytechnic University, via Conca 71, Ancona, 60020, Italy
| | - Simona Lattanzi
- Neurological Clinic, Marche Polytechnic University, via Conca 71, Ancona, 60020, Italy
| | - Giovanna Viticchi
- Neurological Clinic, Marche Polytechnic University, via Conca 71, Ancona, 60020, Italy
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine, Ospedali Riuniti, via Conca 71, Ancona, 60020, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Marche Polytechnic University, via Conca 71, Ancona, 60020, Italy
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13
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Delesie M, Knaepen L, Verbraecken J, Weytjens K, Dendale P, Heidbuchel H, Desteghe L. Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation. Front Cardiovasc Med 2021; 8:758548. [PMID: 34917663 PMCID: PMC8669303 DOI: 10.3389/fcvm.2021.758548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) devices using an automated algorithm for Apnea-Hypopnea Index (AHI) determination can meet the requirements of a good screening tool in AF patients. Methods: This prospective study validated the performance of three PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS)] in consecutive AF patients who were referred for PSG evaluation. Patients wore one of the three PGs simultaneously with PSG, and a different PG during each of three consecutive nights at home. Severity of OSA was classified according to the AHI during PSG (<5 = no OSA, 5–14 = mild, 15–30 = moderate, >30 = severe). Results: Of the 100 included AF patients, PSG diagnosed at least moderate in 69% and severe OSA in 33%. Successful PG execution at home was obtained in 79.1, 80.2 and 86.8% of patients with the ALA, STR and SpS, respectively. For the detection of clinically relevant OSA (AHI ≥ 15), an area under the curve of 0.802, 0.772 and 0.803 was calculated for the ALA, STR and SpS, respectively. Conclusions: This study indicates that home-worn PGs with an automated AHI algorithm can be used as OSA screening tools in AF patients. Based on an appropriate AHI cut-off value for each PG, the device can guide referral for definite PSG diagnosis.
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Affiliation(s)
- Michiel Delesie
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.,Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lieselotte Knaepen
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.,Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and Research Group Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | | | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.,Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium.,Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
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14
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Domínguez-Mayoral A, Sánchez-Gómez J, Guerrero P, Ferrer M, Gutiérrez C, Aguilar M, Fouz-Rosón N, Benítez JM, Pérez-Sánchez S, Gamero-García MÁ, De Torres-Chacón R, Barragán-Prieto A, Algaba P, Ruiz-Bayo L, Montaner J. High prevalence of obstructive sleep apnea syndrome in Spain's Stroke Belt. J Int Med Res 2021; 49:3000605211053090. [PMID: 34719990 PMCID: PMC8562644 DOI: 10.1177/03000605211053090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among patients with acute ischemic stroke (AIS) in southern Spain. Methods We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests. Results Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients. Conclusions The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.
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Affiliation(s)
- Ana Domínguez-Mayoral
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Jesús Sánchez-Gómez
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Patricia Guerrero
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Marta Ferrer
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Carmen Gutiérrez
- Neurophysiology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - María Aguilar
- Neurophysiology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Natalia Fouz-Rosón
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - José María Benítez
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Soledad Pérez-Sánchez
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Miguel Ángel Gamero-García
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Reyes De Torres-Chacón
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Ana Barragán-Prieto
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Lidia Ruiz-Bayo
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Joan Montaner
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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15
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Touil I, Amor HIH, Kechida M, Boudawara NK, Brahem Y, Bouchareb S, Hasnaoui MT, Boussoffara L, Knani J. Predictive echocardiographic factors of severe obstructive sleep apnea. Pan Afr Med J 2021; 38:359. [PMID: 34367438 PMCID: PMC8308867 DOI: 10.11604/pamj.2021.38.359.28470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction obstructive sleep apnea (OSA) is a common chronic pulmonary disease, characterized by repetitive collapse of the upper respiratory airways, leading to oxygen desaturation. This condition is recognized to be associated with cardiovascular disease. Several studies have shown the effects of OSA on both geometry and cardiac function, with conflicting results. We aimed to investigate the relationship between echocardiographic abnormalities and the severity of OSA. Methods this is a cross-sectional single center study including patients, without any cardiovascular or pulmonary comorbidities, with polygraphy proven OSA. All participants underwent a detailed transthoracic echocardiography (TTE). Results a total of 93 patients were included in the study, with 62.2% (n=56) females. According to the apnea hypopnea index (AHI), patients were divided into two groups: mild to moderate OSA (5≤ AHI< 30/H) and severe OSA (AHI≥ 30/H). There were no differences in baseline characteristics between the two groups. The assessment of echocardiographic parameters demonstrated that severe OSA have a higher left ventricular end-systolic (LVES) (47.6±7.2 VS 46.2±4.7), left ventricular end-diastolic (LVED) (31.3±6.2 VS 28.9±4.5) diameters and interventricular septum (IVS) thickness (12.7±2.4 VS11.7±2.5) diameters rather than mild to moderate OSA without a significant difference between the two groups. Furthermore, severe OSA patients had lower mean value of left ventricular ejection fraction (LVEF) and fractional shortening (FS) equal to 62.1±9.7 and 32.5±6.3 respectively. The difference between the two groups was not statistically significant. However, a significant association was shown between severity of OSA and left ventricular (LV) diastolic dysfunction, right ventricular internal diameter (RVID) and systolic pulmonary artery pressure (sPAP), with p=0.05, p=0.05 and p= 0.03 respectively. The RVID was also independently associated to the severity of the OSA (aOR 1.33, 95%CI: 0.99-1.79; p=0.05). Conclusion using bidimensional echocardiography showed a relationship between severe OSA and right ventricular parameters (diastolic dysfunction and RVID) and sPAP.
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Affiliation(s)
- Imen Touil
- Department of Pneumology, Taher Sfar Hospital, Mahdia, Tunisia
| | | | - Melek Kechida
- Department of Internal Medicine, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Yosra Brahem
- Department of Pneumology, Taher Sfar Hospital, Mahdia, Tunisia
| | | | | | | | - Jalel Knani
- Department of Pneumology, Taher Sfar Hospital, Mahdia, Tunisia
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16
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Edouard P, Campo D, Bartet P, Yang RY, Bruyneel M, Roisman G, Escourrou P. Validation of the Withings Sleep Analyzer, an under-the-mattress device for the detection of moderate-severe sleep apnea syndrome. J Clin Sleep Med 2021; 17:1217-1227. [PMID: 33590821 DOI: 10.5664/jcsm.9168] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES To assess the diagnostic performance of a nonintrusive device placed under the mattress to detect sleep apnea syndrome. METHODS One hundred eighteen patients suspected to have obstructive sleep apnea syndrome completed a night at a sleep clinic with a simultaneous polysomnography (PSG) and recording with the Withings Sleep Analyzers. PSG nights were scored twice: first as simple polygraphy, then as PSG. RESULTS Average (standard deviation) apnea-hypopnea index from PSG was 31.2 events/h (25.0) and 32.8 events/h (29.9) according to the Withings Sleep Analyzers. The mean absolute error was 9.5 events/h. The sensitivity, specificity, and area under the receiver operating characteristic curve at thresholds of apnea-hypopnea index ≥ 15 events/h were, respectively, sensitivity (Se)15 = 88.0%, specificity (Sp)15 = 88.6%, and area under the receiver operating characteristic curve (AUROC) 15 = 0.926. At the threshold of apnea-hypopnea index ≥ 30 events/h, results included Se30 = 86.0%, Sp30 = 91.2%, AUROC30 = 0.954. The average total sleep time from PSG and the Withings Sleep Analyzers was 366.6 (61.2) and 392.4 (67.2) minutes, sleep efficiency was 82.5% (11.6) and 82.6% (11.6), and wake after sleep onset was 62.7 (48.0) and 45.2 (37.3) minutes, respectively. CONCLUSIONS Withings Sleep Analyzers accurately detect moderate-severe sleep apnea syndrome in patients suspected of sleep apnea syndrome. This simple and automated approach could be of great clinical value given the high prevalence of sleep apnea syndrome in the general population. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Validation of Withings Sleep for the Detection of Sleep Apnea Syndrome; URL: https://clinicaltrials.gov/ct2/show/NCT04234828; Identifier: NCT04234828.
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Affiliation(s)
| | | | | | | | - Marie Bruyneel
- Chest Service, Saint-Pierre University Hospital, Brussels, Belgium
| | - Gabriel Roisman
- AP-HP, Sleep Medicine Department, Antoine-Béclère Hospital, Clamart, France
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17
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Mohammadieh AM, Sutherland K, Kanagaratnam LB, Whalley DW, Gillett MJ, Cistulli PA. Clinical screening tools for obstructive sleep apnea in a population with atrial fibrillation: a diagnostic accuracy trial. J Clin Sleep Med 2021; 17:1015-1024. [PMID: 33560210 DOI: 10.5664/jcsm.9098] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF), there is a paucity of data around its diagnosis and management in patients with AF. The objectives of this study were to compare the diagnostic accuracy of commonly used OSA screening tools in an AF population, including a level 3 portable sleep study device, and to examine the epidemiology of OSA in a hospital cohort with AF. METHODS One hundred seven patients with AF recruited from 2 tertiary centers underwent a panel of OSA screening tools and in-laboratory polysomnography in randomized order. RESULTS Oxygen desaturation index derived from a level 3 portable sleep study device performed best for moderate to severe and severe OSA, with excellent diagnostic accuracy (area under the curve, 0.899; 95% confidence interval, 0.838-0.960 and area under the curve, 0.925; 95% confidence interval, 0.859-0.991, respectively). Sixty-seven patients (62.6%) were newly diagnosed with OSA (31.8% mild, 18.7% moderate, 12.1% severe). CONCLUSIONS Undiagnosed OSA is highly prevalent in a hospital AF cohort. However, it is characterized by a relative paucity of symptoms, markedly limiting the usefulness of history or screening questionnaires. This is the first study to find that a level 3 home sleep study device shows excellent diagnostic accuracy in patients with AF. This finding may inform AF management guidelines. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Name: The validity and reliability of a portable device for the diagnosis of Obstructive Sleep Apnoea in patients with Atrial Fibrillation; URL:https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371024; Identifier: ACTRN12616001016426.
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Affiliation(s)
- Anna M Mohammadieh
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Logan B Kanagaratnam
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David W Whalley
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark J Gillett
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Emergency Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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18
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Małolepsza A, Kudrycka A, Karwowska U, Hoshino T, Wibowo E, Pál Böjti P, Białas A, Kuczyński W. The role of screening questionnaires in the assessment of risk and severity of obstructive sleep apnea - polysomnography versus polygraphy. Adv Respir Med 2021; 89:188-196. [PMID: 33966264 DOI: 10.5603/arm.a2021.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
Obstructive sleep apnea (OSA) is a disease of significant importance, which may lead to numerous severe clinical consequences. The gold standard in the diagnosis of this sleep-related breathing disorder (SRBD) is polysomnography (PSG). However, due to the need for high expertise of staff who perform this procedure, its complexity, and relatively low availability, some simpler substitutes have been developed; among them is polygraphy (PG), which is most widely used. Also, there is a variety of questionnaires suitable to assess the pre-test probability and severity of OSA. The most frequently used ones are the STOP-BANG questionnaire (SBQ), NoSAS questionnaire, and Berlin questionnaire (BQ). However, they have different sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) when being used in various populations. The aim of this study is to provide a concise and clinically-oriented review of the most frequently used questionnaires, with special attention to its strengths and limitations. Moreover, we discuss whether PSG or PG would be more preferred for confirming OSA diagnosis with the highest likelihood.
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Affiliation(s)
- Aleksandra Małolepsza
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Aleksandra Kudrycka
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland.
| | - Urszula Karwowska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Tetsuro Hoshino
- Department of Sleep Medicine and Sleep Disorder Center, Aichi Medical University, Aichi, Japan
| | - Erik Wibowo
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Péter Pál Böjti
- Department of Neurointervention, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Adam Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, Lodz, Poland
| | - Wojciech Kuczyński
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
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19
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Nguyen DB, Khirani S, Griffon L, Baujat G, Michot C, Marzin P, Rondeau S, Luscan R, Couloigner V, Pejin Z, Zerah M, Cormier-Daire V, Fauroux B. Sleep-disordered breathing and its management in children with rare skeletal dysplasias. Am J Med Genet A 2021; 185:2108-2118. [PMID: 33908178 DOI: 10.1002/ajmg.a.62236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/12/2021] [Accepted: 04/03/2021] [Indexed: 11/10/2022]
Abstract
Sleep-disordered breathing (SDB) is common in patients with skeletal dysplasias. The aim of our study was to analyze SDB and respiratory management in children with rare skeletal dysplasias. We performed a retrospective analysis of patients with spondyloepiphyseal dysplasia congenita (SEDC), metatropic dysplasia (MD), spondyloepimetaphyseal dysplasia (SEMD), acrodysostosis (ADO), geleophysic dysplasia (GD), acromicric dysplasia (AD), and spondylocostal dysplasia (SCD) between April 2014 and October 2020. Polygraphic data, clinical management, and patients' outcome were analyzed. Thirty-one patients were included (8 SEDC, 3 MD, 4 SEMD, 1 ADO, 4 GD, 3 AD, and 8 SCD). Sixteen patients had obstructive sleep apnea (OSA): 11 patients (2 with SEDC, 1 with SEMD, 1 with ADO, 1 with GD, 2 with AD, and 4 with SCD) had mild OSA, 2 (1 SEMD and 1 GD) had moderate OSA, and 3 (1 SEDC, 1 MD, 1 SEMD) had severe OSA. Adenotonsillectomy was performed in one patient with SCD and mild OSA, and at a later age in two other patients with ADO and AD. The two patients with moderate OSA were treated with noninvasive ventilation (NIV) because of nocturnal hypoxemia. The three patients with severe OSA were treated with adenotonsillectomy (1 SEDC), adeno-turbinectomy and continuous positive airway pressure (CPAP; 1 MD), and with NIV (1 SEMD) because of nocturnal hypoventilation. OSA and/or alveolar hypoventilation is common in patients with skeletal dysplasias, underlining the importance of systematic screening for SDB. CPAP and NIV are effective treatments for OSA and nocturnal hypoventilation/hypoxemia.
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Affiliation(s)
- Duy Bo Nguyen
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Pediatric Department, Vinmec Times City Hospital, Hanoi, Vietnam
| | - Sonia Khirani
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris University, Paris, France.,ASV Santé, Gennevilliers, France
| | - Lucie Griffon
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris University, Paris, France
| | - Geneviève Baujat
- AP-HP, Hôpital Necker-Enfants Malades, Genetics Department, National Reference Centre for Skeletal Dysplasia, Paris University, INSERM UMR 1163, Institut Imagine, Paris, France
| | - Caroline Michot
- AP-HP, Hôpital Necker-Enfants Malades, Genetics Department, National Reference Centre for Skeletal Dysplasia, Paris University, INSERM UMR 1163, Institut Imagine, Paris, France
| | - Pauline Marzin
- AP-HP, Hôpital Necker-Enfants Malades, Genetics Department, National Reference Centre for Skeletal Dysplasia, Paris University, INSERM UMR 1163, Institut Imagine, Paris, France
| | - Sophie Rondeau
- AP-HP, Hôpital Necker-Enfants Malades, Genetics Department, National Reference Centre for Skeletal Dysplasia, Paris University, INSERM UMR 1163, Institut Imagine, Paris, France
| | - Romain Luscan
- AP-HP, Hôpital Necker-Enfants malades, Pediatric Otolaryngology Department, National Reference Centre for ENT Rare Malformations, Paris, France
| | - Vincent Couloigner
- AP-HP, Hôpital Necker-Enfants malades, Pediatric Otolaryngology Department, National Reference Centre for ENT Rare Malformations, Paris, France
| | - Zagorka Pejin
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Orthopedic Surgery, Paris, France
| | - Michel Zerah
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Neurosurgery, Centre de Référence des Malformations Craniofaciales - CRMR CRANIOST, Paris, France
| | - Valérie Cormier-Daire
- AP-HP, Hôpital Necker-Enfants Malades, Genetics Department, National Reference Centre for Skeletal Dysplasia, Paris University, INSERM UMR 1163, Institut Imagine, Paris, France
| | - Brigitte Fauroux
- AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris University, Paris, France
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20
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Rao F, Garuti G, Vitacca M, Banfi P, Racca F, Cutrera R, Pavone M, Pedemonte M, Schisano M, Pedroni S, Casiraghi J, Vianello A, Sansone VA. Management of respiratory complications and rehabilitation in individuals with muscular dystrophies: 1st Consensus Conference report from UILDM - Italian Muscular Dystrophy Association (Milan, January 25-26, 2019). Acta Myol 2021; 40:8-42. [PMID: 33870094 PMCID: PMC8033426 DOI: 10.36185/2532-1900-045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022]
Abstract
Respiratory complications are common in the patient with muscular dystrophy. The periodic clinical and instrumental respiratory evaluation is extremely important. Despite the presence in the literature of updated guidelines, patient associations often report lack of knowledge of these pathologies, particularly in peripheral hospitals. The purpose of this work, inspired by the Italian Muscular Dystrophy Association (UILDM) is to improve management of respiratory problems necessary for the management of these patients complex. To this end, the main items that the specialist can meet in the follow-up of these pathologies have been analyzed and discussed, among which the respiratory basal evaluation, the criteria of adaptation to non-invasive ventilation, management of bronchial secretions, situations of respiratory emergency, indications for tracheostomy and the subject of advance directives of treatment (DAT).
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Affiliation(s)
- Fabrizio Rao
- Respiratory Unit, NEuroMuscular OmniCentre (NeMO), Serena Onlus Foundation, Niguarda Hospital, Milan, Italy
| | - Giancarlo Garuti
- Pneumology Unit, Santa Maria Bianca Hospital, AUSL Modena, Italy
| | | | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Fabrizio Racca
- Department of Anaesthesia and Intensive Care, Division of Paediatric Intensive Care Unit, Alessandria General Hospital, Alessandria, Italy
| | - Renato Cutrera
- Pulmonology Unit, Academic Paediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Marina Pedemonte
- Pediatric Neurology and Muscle Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Matteo Schisano
- Respiratory Medicine Unit, AOU "Policlinico-San Marco", Catania, Italy
| | - Stefania Pedroni
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
| | - Jacopo Casiraghi
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Valeria A Sansone
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
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21
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Zhang XL, Wang W, Xiao Y. Sleep Disordered Breathing Diagnosis and Treatment During the COVID-19 Pandemic: A Nationwide Survey in China. Nat Sci Sleep 2021; 13:21-30. [PMID: 33447115 PMCID: PMC7802770 DOI: 10.2147/nss.s292373] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has markedly impacted the distribution of medical resources and healthcare delivery systems. The objective of this study was to investigate the influence of the pandemic on the diagnosis and treatment of sleep-disordered breathing (SDB) in China. METHODS A retrospective online survey of sleep centers from the assembly of SDB of the Chinese Thoracic Society was conducted from July 1 to July 20, 2020. The questionnaire focused on four main aspects: 1) general information about the centers; 2) changes in SDB management activities, including patient volumes, diagnostic and positive airway pressure (PAP) titration procedures, and follow-up methods, from February to June 2020, compared with before; 3) the application of telemedicine and sleep specialists' self-assessments of knowledge and their perspectives on telemedicine; and 4) changes in medical staff active in sleep services during the pandemic compared with before. RESULTS Fifty-three (96%) of the sleep centers responded to the survey. During the early stage of the outbreak, SDB medical services were dramatically reduced to 5-10% of the pre-epidemic level, and laboratory-based polysomnograms and manual titration were almost cancelled. With the subsidence of COVID-19, SDB medical services gradually resumed to approximately half of the pre-pandemic level by June. However, a second wave of COVID-19 in Beijing significantly reduced the recovery of SDB services. The application of polygraphy has increased significantly. Home-initiated PAP and telemedicine still accounted for a small part of SDB management during the pandemic. CONCLUSION The COVID-19 pandemic has greatly challenged SDB management in China. Polygraphy played a major role in SDB diagnosis during the pandemic. Home-based SDB management and telemedicine have not been well implemented. The second surge of COVID-19 in Beijing cut back on the recovering SDB service to the early outbreak level, which may give us an impetus to restructure our sleep health service.
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Affiliation(s)
- Xiao Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China.,The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.,Capital Medical University, Beijing, People's Republic of China.,Peking University Health Science Center, Beijing, People's Republic of China
| | - Wei Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chinese Medical University, Shenyang, People's Republic of China
| | - Yi Xiao
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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22
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Kallel S, Kchaou K, Jameleddine A, Sellami M, Mnejja M, Charfeddine I. Snoring time versus snoring intensity: Which parameter correlates better with severity of obstructive sleep apnea syndrome? Lung India 2020; 37:300-303. [PMID: 32643637 PMCID: PMC7507915 DOI: 10.4103/lungindia.lungindia_394_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The relationship between the severity of obstructive sleep apnea syndrome (OSAS) and both snoring intensity and rate measured objectively has not been sufficiently investigated. The aim of this study was to evaluate the relationship between severity of OSAS and snoring parameters including snoring intensity and rate. Patients and Methods: A total of 150 records of individuals who complained of snoring were analyzed. Patients were classified into four groups according to apnea–hypopnea index (AHI). Polygraphy recordings including the snoring intensity and the snoring rate (defined as the percentage of snoring time during the total sleep time) and the clinical data were compared and analyzed. Results: AHI was significantly correlated, respectively, with snoring rate (r = 0.341; P < 0.0001) and maximal intensity of snoring (r = 0.362; P < 0.0001). However, no correlation was found between the average intensity of snoring and AHI (P = 0.33). When assessing each respiratory event individually, snoring rate was more correlated with hypopnea index (r = 0.424; P < 0.0001) than with AI (r = 0.233; P = 0.004). The snoring rate (%) in the severe OSAS group (31.79 ± 19.3) was significantly higher than that in the mild OSAS group (18.02 ± 17; P = 0.001) and the control group (17 ± 16.57; P = 0.011). Similarly, the maximal intensity of snoring (db) in the severe OSAS group (90.45 ± 13.79) was higher than that in the mild OSAS group (86.46 ± 15.07; P = 0.006) and the control group (84.75 ± 6.65; P < 0.001). Conclusion: The snoring rate and maximal intensity of snoring correlate better with the severity of OSAS than average snoring intensity.
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Affiliation(s)
- Souha Kallel
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Khouloud Kchaou
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Asma Jameleddine
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Moncef Sellami
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Malek Mnejja
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
| | - Ilhem Charfeddine
- Department of ENT and Cervicofacial Surgery, Habib Bourguiba's Teaching Hospital, 3029 Sfax, Tunisia
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23
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Barczok M. [Heart attack, Stroke or Diabetes - always consider sleep apnea]. MMW Fortschr Med 2020; 162:71-72. [PMID: 32405832 DOI: 10.1007/s15006-020-0484-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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24
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Tabone L, Khirani S, Olmo Arroyo J, Amaddeo A, Sabil A, Fauroux B. Cerebral Oxygenation During Respiratory Events in Children with Sleep-Disordered Breathing and Associated Disorders. J Pediatr 2019; 214:134-140.e7. [PMID: 31540763 DOI: 10.1016/j.jpeds.2019.07.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/12/2019] [Accepted: 07/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate changes in cerebral oxygenation by means of near-infrared spectroscopy during respiratory events in children with sleep-disordered breathing (SDB) and associated disorders. STUDY DESIGN Sixty-five children suspected of having SDB underwent a respiratory polygraphy with simultaneous recording of cerebral oxygenation indices. Respiratory events were analyzed by type of event, duration, variations of pulse oximetry (oxygen saturation [SpO2]), cerebral tissue oxygenation index (TOI), and heart rate. Data were categorized according to the severity of SDB and age. RESULTS There were 540 obstructive and mixed apneas, 172 central apneas, and 393 obstructive hypopneas analyzed. The mean decreases in SpO2 and TOI were 4.1 ± 3.1% and 3.4 ± 2.8%, respectively. The mean TOI decrease was significantly smaller for obstructive hypopnea compared with apneas. The TOI decrease was significantly less in children with mild SDB as compared with those with moderate-to-severe SDB and in children >7 years as compared with those <7 years old. TOI decreases correlated significantly with SpO2 decreases, duration of event, and age, regardless of the type of event. In a multivariable regression model, predictive factors of TOI decreases were the type of respiratory event, SpO2 decrease, apnea-hypopnea index, and age. CONCLUSIONS In children with SDB and associated disorders, cerebral oxygenation variations depend on the type of respiratory event, severity of SDB, and age.
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Affiliation(s)
- Laurence Tabone
- Research Unit French Institute of Health and Medical Research U 955, team 13, Créteil, France.
| | - Sonia Khirani
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France; ASV Santé, Gennevilliers, France
| | - Jorge Olmo Arroyo
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France
| | - Alessandro Amaddeo
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France
| | | | - Brigitte Fauroux
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France
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25
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Ikizoglu NB, Kiyan E, Polat B, Ay P, Karadag B, Ersu R. Are home sleep studies useful in diagnosing obstructive sleep apnea in children with down syndrome? Pediatr Pulmonol 2019; 54:1541-1546. [PMID: 31290291 DOI: 10.1002/ppul.24440] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 06/06/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND AIM Obstructive sleep apnea syndrome (OSAS) is frequent in children with Down syndrome (DS) and polysomnography (PSG) is recommended for all children with DS. However PSG is not always available and alternative diagnostic methods are needed. The aim of the study was to evaluate the feasibility and validity of home polygraphy (HPG) in children with DS. METHODS A national DS association was contacted and children aged 6 to 18 years who accepted to participate were recruited. Otorhinolaryngologic evaluation, in-lab PSG and HPG were performed. OSAS was diagnosed by PSG with an apnea-hypopnea index (AHI) more than or equal to 1. OSAS severity was classified as moderate-to-severe if AHI was more than or equal to 5. Receiver operating characteristic curves were calculated for HPG using PSG as the gold standard. RESULTS Nineteen children (12 girls) completed the study. Median age was 11.3 years. Demographic and clinical characteristics were similar in children with and without OSAS. Eighty-nine percent of HPG studies were technically acceptable at the initial night and the success rate was 100% when two failed studies were repeated. PSG revealed OSAS in six (32%) children, two had mild and four had moderate-to-severe OSAS. All four patients with moderate-to-severe OSAS diagnosed with PSG have been diagnosed with the same severity on HPG. HPG had 100% sensitivity and 83% specificity when AHI ≥ 3 was set as diagnostic criteria. CONCLUSION HPG is a feasible and reliable test of OSAS in children with DS and may be useful in diagnosis and treatment of patients with moderate-to-severe OSAS in this patient group.
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Affiliation(s)
- Nilay Bas Ikizoglu
- Department of Pediatric Pulmonology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Esen Kiyan
- Department of Pulmonology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Beldan Polat
- Department of Otorhinolaryngology, Head and Neck Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Ay
- Department of Public Health, Marmara University Medical Faculty, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Refika Ersu
- Department of Pediatric Pulmonology, Marmara University Medical Faculty, Istanbul, Turkey
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26
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Abstract
Post-conviction polygraph testing of sex offenders (typically referred to as PCSOT) is common in the US, increasingly applied in England and Wales, but hardly if ever used elsewhere in the world. This article provides an account of the nature and aims of PCSOT, research into its efficacy, and controversies associated with it.
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Affiliation(s)
- Don Grubin
- a Newcastle University , Newcastle upon Tyne , UK
| | - Maxim Kamenskov
- b Laboratory of Forensic Sexology, V. Serbsky National Medical Research Centre for Psychiatry and Addiction of the Ministry of Health of the Russian Federation , Moscow , Russian Federation
| | - R Gregg Dwyer
- c Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston , SC , USA
| | - Tim Stephenson
- c Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston , SC , USA
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27
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Grote L. How to organise teaching activities for the scoring of cardiorespiratory polygraphies? Experiences from three Swedish Sleep Society teaching courses. J Sleep Res 2018; 28:e12774. [PMID: 30246416 DOI: 10.1111/jsr.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/30/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
Education in the scoring of sleep-disordered breathing is organised differently and data on the evaluation of teaching strategies based on student ratings are sparse. The aim of the study was to analyse the gain in theoretical and practical knowledge achieved during different course settings offered by a national sleep society. The course contained 1 hr of theoretical teaching (scoring rules and recording methodology) and 2.5 hr of practical scoring (physiological breathing, obstructive/central sleep apnea and hypoventilation). Three different settings were provided: a large scoring group including participants with mixed experiences (1), a small scoring group with inexperienced scorers (2), and guided scoring for experienced scorers (3). Evaluation was performed at the end of the course. Data from 67 out of 82 participants (79%) were analysed (42 nurses/technicians and 25 physicians/dentists). Previous scoring experience was limited, moderate and extended in 25, 26, and 15 students, respectively. Gain of practical knowledge and overall course rating were significantly higher in settings 2 and 3 compared with 1 (p = 0.005 and p = 0.018 respectively). Guided scoring was the preferred practical teaching setting in experienced scorers, whereas scoring in large groups together with an experienced student was preferred in newcomers. Profession did not influence gain of knowledge, course satisfaction or preferred course design. From the student's perspective, consensus scoring in groups or guided scoring for all students may have advantages compared with single/small-group scoring settings. Technical teaching knowledge of faculty members is of significant importance.
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Affiliation(s)
- Ludger Grote
- Centre for Sleep and Wakefulness Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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28
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Ekiz T, Pazarli AC. Sleep disorders require a comprehensive evaluation and confirmation with polysomnography in patients with multiple sclerosis. Eur J Neurol 2017; 24:e28. [PMID: 28417579 DOI: 10.1111/ene.13284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- T Ekiz
- Department of Physical Medicine and Rehabilitation, Dermancan Medical Center, Adana, Turkey
| | - A C Pazarli
- Department of Pulmonary Diseases, Elbistan State Hospital, Kahramanmaraş, Turkey
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29
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Amaddeo A, Fernandez-Bolanos M, Olmo Arroyo J, Khirani S, Baffet G, Fauroux B. Validation of a Suprasternal Pressure Sensor for Sleep Apnea Classification in Children. J Clin Sleep Med 2016; 12:1641-1647. [PMID: 27655466 DOI: 10.5664/jcsm.6350] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 08/08/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The recognition and characterization of respiratory events is crucial when interpreting sleep studies. The aim of the study was to validate the PneaVoX sensor, which integrates the recording of respiratory effort by means of suprasternal pressure (SSP), respiratory flow, and snoring for the classification of sleep apneas in children. METHODS Sleep recordings of 20 children with a median age of 7.5 (0.5-16.5) years were analyzed. Scoring of apneas according to the American Academy of Sleep Medicine (AASM) guidelines using nasal pressure, oronasal thermal sensor and respiratory efforts by means of respiratory inductance plethysmography (RIP), was compared to a scoring using the PneaVoX sensor and nasal pressure, without the oronasal thermal sensor nor RIP, during a dual blind study. RESULTS The percentage of sleep time recording without artifacts was 97%, 97%, 87%, 65%, and 98% for the respiratory flow and SSP from the PneaVoX sensor, oronasal thermal sensor, nasal pressure, and RIP, respectively. As compared to the AASM scoring with RIP, sensitivity and specificity of the SSP for the scoring of central apneas were 75% and 99% for the first reader, and 70% and 100% for the second reader, respectively. Sensitivity and specificity for the scoring of obstructive apneas were 98% and 75%, and 100% and 70%, respectively. A significant number of apneas scored as central by RIP were scored as obstructive by the SSP. CONCLUSIONS The PneaVoX sensor has a high degree of scorability in children. The PneaVoX sensor is a useful adjunct for characterizing apneas.
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Affiliation(s)
- Alessandro Amaddeo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, Paris, France.,Research unit INSERM U 955, team 13, Créteil, France
| | - Marta Fernandez-Bolanos
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Jorge Olmo Arroyo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France
| | - Sonia Khirani
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,ASV Santé, Gennevilliers, France
| | | | - Brigitte Fauroux
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,Paris Descartes University, Paris, France.,Research unit INSERM U 955, team 13, Créteil, France
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Amaddeo A, Moreau J, Frapin A, Khirani S, Felix O, Fernandez-Bolanos M, Ramirez A, Fauroux B. Long term continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) in children: Initiation criteria in real life. Pediatr Pulmonol 2016; 51:968-74. [PMID: 27111113 DOI: 10.1002/ppul.23416] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Long term noninvasive continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are increasingly used in children but limited information is available on the criteria and conditions leading to the initiation of these treatments. The aim of the study is to describe the objective overnight respiratory parameters and clinical situations that led to the initiation of CPAP/NIV in a pediatric NIV unit. MATERIAL AND METHODS Retrospective analysis of the data of all the children discharged on home CPAP/NIV over a 1 year period. RESULTS Seventy-six patients were started on CPAP (n = 64) or NIV (n = 12). CPAP/NIV was initiated because of CPAP/NIV weaning failure (Acute group) in 15 patients. None of these patients had an overnight gas exchange or sleep study before CPAP/NIV initiation. In 18 patients, CPAP/NIV was initiated on abnormal nocturnal gas exchange alone (Subacute group). These patients had a median of three of the following five overnight gas exchange abnormalities: minimal pulse oximetry (SpO2 ) <90%, maximal transcutaneous carbon dioxide (PtcCO2 ) >50 mmHg, time spent with SpO2 <90% or PtcCO2 >50 mmHg ≥2% of recording time, oxygen desaturation index >1.4/hr. In the last 43 patients, CPAP/NIV was initiated after an abnormal sleep study (Chronic group) on a mean of four of the aforementioned criteria and an apnea-hypopnea index >10/hr. CONCLUSION In clinical practice, CPAP/NIV was initiated in an acute, subacute and chronic setting with most patients having an association of several abnormal gas exchange or sleep study parameters. Future studies should evaluate the effectiveness and benefits of CPAP/NIV according to the clinical situation and initiation criteria. Pediatr Pulmonol. 2016; 51:968-974. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- A Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,Paris Descartes University, Paris, France.,Inserm U955 Team 13, 94000, Creteil, France
| | - J Moreau
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,Department of Physiology, University of Montpellier I, Montpellier, France
| | - A Frapin
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France
| | - S Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,ASV Santé, Gennevilliers, France
| | - O Felix
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,Department of Pediatric, CHU de Rouen, Rouen, France
| | - M Fernandez-Bolanos
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France
| | - A Ramirez
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,ADEP ASSISTANCE, Suresnes, France
| | - B Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris 75015, France.,Paris Descartes University, Paris, France.,Inserm U955 Team 13, 94000, Creteil, France
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Pavone M, Caldarelli V, Khirani S, Colella M, Ramirez A, Aubertin G, Crinò A, Brioude F, Gastaud F, Beydon N, Boulé M, Giovannini-Chami L, Cutrera R, Fauroux B. Sleep disordered breathing in patients with Prader-Willi syndrome: A multicenter study. Pediatr Pulmonol 2015; 50:1354-9. [PMID: 25851435 DOI: 10.1002/ppul.23177] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/05/2015] [Accepted: 02/20/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Sleep disordered breathing (SDB) is common in patients with Prader-Willi syndrome (PWS) and systematic screening is recommended, especially before growth hormone treatment. The aim of the study was to describe the baseline SDB and therapeutic interventions in a large cohort of patients. STUDY DESIGN Retrospective study. SUBJECT SELECTION Eighty-eight patients with PWS, median [interquartile range] age of 5.1 [1.0-14.5] years old (range 0.3-44.3), who were followed in three centers (France, Italy). METHODOLOGY Anthropometrics, polygraphy (PG), and gas exchange data were analyzed. RESULTS Median body mass index (BMI) was 20 [16-34] kg/m(2), BMI z-score for patients aged 2-20 years old was 2.1 [1.2-2.8] SD, mixed-obstructive apnea-hypopnea index (MOAHI) 1.8 [0.6-5.0] events/hr, and central apnea index (CAI) 0.1 [0.0-0.6] events/hr. Minimum pulse oximetry (SpO2) was 88 [84-91]%, percentage of time with SpO2 <90% 0.1 [0.0-1.0]%, and oxygen desaturation index 2 [1-4]/hr. An apnea-hypopnea index (AHI) ≥ 1.5 and ≥ 5 events/hr was observed in 53% of children and 41% of adults, respectively. No correlations were observed between MOAHI and anthropometrics data (age, BMI, BMI z-score), while MOAHI significantly correlated with SpO2 indexes. Age and BMI only weakly correlated with SpO2 indexes. Growth hormone could be initiated in 48 patients. Regarding post-PG therapy, 9 patients had upper airway surgery, and noninvasive CPAP/bilevel ventilation was started in 16 patients. CONCLUSIONS Patients with PWS exhibit a high prevalence of SDB. The lack of association between obesity and SDB leads to hypothesize that hypotonia and/or facial dysmorphic features may play a major role in the occurrence of SDB.
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Affiliation(s)
- Martino Pavone
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy
| | - Valeria Caldarelli
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy.,Pediatric Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,ASV Santé, Gennevilliers, France
| | | | - Adriana Ramirez
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,ADEP Assistance, Suresnes, France
| | - Guillaume Aubertin
- Pediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Antonino Crinò
- Endocrinology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Frédéric Brioude
- Endocrinology Unit, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Frédérique Gastaud
- Endocrinology Unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Nicole Beydon
- Lung Function and Sleep Unit, Physiology Department, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Michèle Boulé
- Lung Function and Sleep Unit, Physiology Department, AP-HP, Hôpital Armand Trousseau, Paris, France.,Pierre et Marie Curie University - Paris 6, Paris, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonary-Allergy Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.,Université de Nice Sophia Antipolis, Nice, France
| | - Renato Cutrera
- Respiratory Unit, Bambino Ges, ù, Children's Hospital, Rome, Italy
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, H, ô, pital Necker, Paris, France.,Paris Descartes University, Paris, France.,INSERM U 955, Equipe 13, Créteil, France
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